There has long been a debate on public vs. private health care in Canada though sometimes it is seen as not to the level of its importance. Canada has privately delivered health care and privately funded health care and the most prevalent one is privately health care. They usually operate on profit basis such as radiology centre, local non-hospital lab. Many of the rendered services tend to be publicly funded, for example, covered by Medicare; however the non-essential services are not. This is contrary to the public health care which is run by government. Their services are publicly delivered not for making profit.

The need for privatization of the health care has been of great interest for the future Canadian Health Care system. Nevertheless, a significant component of private care under current system has already existed, such as dental services, cosmetic surgeries, drug and many others. In 2006, according to Health Care in Canada, approximately $142 billion, or $4,411 per person was spent on health care. On taking inflation into consideration, it amounted to nearly three times the spending of 1975. Out of this, only $98.8 billion was the spending of governments that delivers public health care. Another $43.2 billion became spent privately for additional services (Robert Steinbrook, M.D., 2006).

The often publicly funded system tend to experience long wait times by the patients that extend to even the essential required services such as hip or knee replacements, emergency room visit and to some occasions may go to as far as radiation treatment for cancer. This explains the reasons as to why there are thriving private surgery clinics. Some as well are to the idea that more should be privately run and privately funded in order to ease the backlog that is experienced within the public system. Whereas those who oppose the move see privatization as a tool that due to the reasons that physicians have to choose between the private and public system, in case of more opening of privately funded centers, it will result to an exodus of health care workers, physicians as well as philanthropic funding out of the public system that would otherwise erode the public systems further, (Canadian Institute for Health Information, 2007).

The problem that is experienced with wait times may be done away with by increasing supply. When the provision in terms of treatment is sufficiently high, then no queue will be there. Like nations which have not experienced the problems of wait times, Germany, Belgium, France, have been paying their providers on the basis of treatment volumes as well as avoiding tight restriction on spending, ( Harrison A, Appleby J.,2005). On the other hand, to keep supply in line with demand might prove to be costly, more particularly due to the fact that an increased supply is able to stimulate further demand; when there is abundant in supply, then there is likelihood of physicians referring patients who previously would have not met treatment criteria. Because of this reasons there are more cost effective supply-side approaches:

Increasing activity directly

Paying for increased activities directly forms the most basic supply-side strategy. Its early efforts include funding for extra activity temporarily; assuming that reducing wait times was just a matter of working down the backlog. However, this short-term injections of funding encourages unsustainable strategies do not address the root causes of the wait list, as well as the backlog reappearing promptly after the money is not anymore. The most current approach of fee-for-service payment tend to stress long-term funding for activity, for example activity-based payment to hospitals, fee for service payment to physicians, or bonuses for attaining extra volume on retaining a base volume. For making sure that the new activity really brings down the wait list, policy makers can be involved in financial reward contingent on wait-time reduction and activity levels. Such combination has been successfully applied in Spain, England, Netherlands among others. The case study of the impact of activity-based funding has been clearly shown by the Netherlands.

As part of the Netherlands' cost-containment strategy, they replaced fee-for-service payment with lump-sum budgeting, as well as wait lists ballooned. Again in the year 1998-2000, there was a strenuous effort for reducing waits by enhancing reporting of wait-related data and resource offering to local wait-reduction projects. Though these efforts had success, like wait time for some procedures went down somehow, but there was no difference to the overall wait lists. A move in 2001 by the government tried to reinstate activity-based funding, giving bonuses to hospitals that managed to clear their wait lists. The initiative needed sharp increase in spending of the healthcare in 2001-2003, leveling in 2004. During this time, wait times and lists went down significantly, and from that time they have not been major changes. For that reason, paying for activity, majorly the one that is combined with paying for wait reduction forms a strategy that has been proved that manages wait times, (Willcox S, Seddon M, Dunn S. et al., 2007). Whatever can be of impediment is not having spare capacity that accommodates more activity. Therefore it is of importance to improve and increase capacity on the manner of its use.

Increasing capacity

When capacity is increased in the public system, comparison of cross-national indicate a consistent connection between capacity, such as overall spending, physicians or acute-care beds, and shorter wait times. Having a proactive targeted investment within public sector capacity tend to be an effective long-term strategy of controlling wait times. For example, England and Denmark looked forward to a rise in terms of demand for coronary revascularization in 1990s; however, Denmark was the only one that made a major investment in staff, equipment and Ors. Before long, the procedure rate of Denmark had outstripped the one of England and wait time started to go down while for England went up.

Obtaining capacity from the private sector

This is another short-term strategy. Even if private sector incorporate technically nonprofit sector, most of the literature within this area compares public with private delivery. Though there has never been any research showing major contribution on wait reduction, it still a short-term strategy that if undertaken correctly then its impact can be felt on the wait time. In some instances where private sectors have been involved, it has happen to fill some of the pressing need, to some extend have reduced waits. Here, the private provider tend to be a small business that is to set up a stand-alone clinic that is to offer a throughout service, especially in order to risk patients. These centers are able to facilitate the precise targeting and efficient use of resources. Although, it is not a requirement for-profit ownership, a section of the clinics tend to be owned by nonprofit organizations or publicly, ( Deber R., 2002). Little evidence shows that there is more efficiency in terms of service delivery, the private opt to type of services that could be run more efficiently (public). The main importance of private involvement tends to be always speeding and ease of setup.

The private sector could be capable of mobilizing resources more quickly as well as deploying them more flexibly, as compared to the public or non-profit sector. Even though Canada has tried this initiative a more emphasis should be put in several of the sectors. For example, in radiation therapy, in order to attain sufficient rapid increase in capacity, they made a contract with new private company which allowed treatment of another additional 1000 per year, thus reduced wait times. This company depended on the spare capacity of non-profit hospital; equipment and location, on the other hand in its ability of recruiting new staff and paying them good bonus for working evenings, it happen to succeed while the non-profit sector had failed. The explanation for the success was revealed that was due to the organization's stand-alone entity (but not a part of a complex and already overburdened system) as well as many efforts that were put in improving the efficiency of service design.

The risk evidences of private delivery have been realized in different places of Canada, more so when the owner tend to be a large corporation that has to bring a profit to its shareholders. According to the evidences, public hospitals experience higher rate of mortality plus higher costs as compared to private hospitals. Sometime the market offers a strong temptation to skimp on quality for cutting the costs, as well as diverting resources from patients care to into profits. These tendency becomes difficult to prevent when the care delivery tend to prove to be complex and involves multiple, hard to observe inputs, for instance long-term care and hospitals. The issue will become less in case a small company has been contracted to offer a simple easy to monitor company such as laboratory. Another tendency of private providers is that they "cherry-pick" healthier patients while leaving the sicker ones to be attended to by the public system. However, it might not be necessarily a problem…[continue]

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